MEDICARE: JUDITH MONDESIR LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW17937	FL
2	104100000X	Social Worker	SW11831	FL
3	101YM0800X	Mental Health Counselor	ISW11831	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861931354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH MONDESIR LCSW

Provider Business Mailing Address
First Line	:	716 HOLCOMB BRIDGE RD
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30071-1325
Country	:	US
Telephone Number	:	678-732-7616
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 GREEN ST NW STE 404
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3366
Country	:	US
Telephone Number	:	678-732-7616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2017
Last Update Date	:	03/19/2026

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Directions to “ JUDITH MONDESIR LCSW” Practice Location

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